HomeMy WebLinkAbout17-069IDENTIFICATION NO. 1-7 -O(O9
r t (Office Use Only)
APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER
CITY OF IOWA CITY (Police Department review must be made between 8 a.m. to 3 p.m., Monday- Friday)
410 East Washington Street
Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application
(3 19) 356-5040
(319) 356-5497 FAX
Fiat ►vl ddlt{ AI
1. Name (REQUIRED) V ic-11 4
2. Address (REQUIRED) [Oa Mla-1-4-ft-T)Nt, Ia SZib I
3. Contact Information (REQUIRED) Email: Cell Phone: 516`3. SS4 Al i(v `I
(All written communication sent via email)
4a. Driver's License expiration date (REQUIRED)
I 05 bo
b. Taxicab Business Name (REQUIRED) _YCuC-� CAP -?0F IOU -\,a C-rn'I
5. Prior experience in transportation of passengers: ti /.4
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Y
Tvoe of offense W hereWen
oy og
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Sta-wA� AlPrca I -t= z Mu5C• ca Or aco
What happened to the charge? (Circle one) T 10 At+
Convicted Dismissed Deferred Suspended PI ad G ilty Other
Have you been arrested / charged with any traffic offenses in the last five years? y
Type of offense Where When
W \ C40,0 Mt.ISL. CO. . 0�3
SPFw POLV CC, 1'2-'14
What happened to the charge? (Circle one) PLCO CtCI L;r'1 ,p
Convicted Dismissed Deferred Suspended Plead Guilty Other V"0
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8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
Where
When
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pgvide the name=
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DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE ct;RT3ED Q
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF R�IEW
0
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
07/2016
APPLICATION FOR TAXICAB VEHICLE DRIVER
Page 2
herebyy certify that I have issued to me by the Iowa epartment of Transportation} a valid Driver's license number
`4'34i3Y,! q`t25 issued on a I Iv/ is expiring on t2{ S 120 . I understand that if I
falsely answer any questions in this application, that this application may be denied. I agree that in making this application, I
consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and
documents relating to this application, and I further agree that, if authorization to be a taxicab driver is granted, to comply at all
times with all of the provisions of Trifle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public)
Signature of Applicant Mv� Date 05t0017
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by ;1it_A;QQ '�kZ63AD on this 1_:;� day of
►A_ -- 1^
I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that
there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi-
dents of the City of Iowa City (Title 5, Chapter 2, City Code).
Expiration date of Driver's license /Z • 0$• ZOZO
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Signature of P4Ke Chief or designee
0r•Os•i.f7
Date
AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO
MORE THAN ONE YEAR FROM THE DATE LISTED BELOW.
Sig e`offCC`ityrlerk or designee
U
Office Use Only
Approved application
DCI report
State certified driving record
Website update
Date
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GemrtAX1DRNBAWEAPPL92G148�W.Doc 07/2016
04/May,2. 2017 4;18PM Div of Criminal Investigation
w&/ u11 Cab 07 10wa wty
STATE OF IOWA
(6 Criminal History Record Check
Request Form
To: Iowa Division of Criminal Investigation
Support Operations Bureau, V Floor
216 Z 7i1 Street
nes tvfolnes, Iowa 50319
I am radoemin D'an IMVn C16erne1 U6M., b -.--A nt__,. __.
No -8414 P. 1/2
(FAX)31933827uo r. uut/002
DCI Account Number; _,9967-F
(IrnpptlmEle) .
From: _'Yellow, Cab of IDwa City
P.0 -Box 428
Iowa City, TA.. 52244
Phone:.
Fax: (319) 339-7302
La6t Name tma,aeio
First Name immdatomI
Middle Namo recommcnasdl.
Date of Birth (mondmo )
Gender (Mondaro
Social Securitv Number (recommended)
`2(�51'��
Male ❑Female
l�7iR �a.�~% 7
Walver.bifOrntaliatr Without a signed walver from the subject of the request, a dompleta criminal history racord iaay, not
be reloasoblc, pet Cade'of Iowa, Chapter 592.2. For complete criminal hlstoryrecord Information, as allowed by laws alway3
•ohtaln a'wetveral nature from the iub jh
eel of e lrerjij ep.
Waiver Releasers hereby give petmbslcn foe the above req • ting omolal ra Condom ai( tows orladnsl binoryrecord chock whh the Divhion ofComlmi
InverlliatlooM). Any wloilmihinorydel In &11 mdnleinadbythoDClmrybetatcmeduallowed bylaw.
WaiverSlgnalrrre: '
Iowa'Crimfn'al H9stor , Record Check -Results • (DCluse ordy)
As of ' "- - l D , a search of the provided name and dale of birth revealed:
No Iowa Criminal History Record found with DCI �7
Iowa Criminal Flistory Record attached, ACI #a 6
DCT initials�4Z4�
DCI:77 (08/2S/10)
Received Time Apr.28. 2017 12'36PM No.8152
May, 2. 2017 4:18PM Div of Criminal Investigation No -8414 P. 2/2
DCI:00662752
NAME: DAN,X
MCFATE,DANIEL RYAN
DOB SEX RAC
19771205 M W
IOWA CRIMINAL HISTORY
MISDEMEANOR CONVICTIONS ONLY DCI 00862752
PAGE 1 OF 1
DATE PRINTED -
2017/05/02
HOT WGT EYE HAIR SKN POB
510 225 ORN BRO MED IA
ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y
TAT L CALF
CCH RECORD ***
01 ARRESTED/TAKEN INTO CUSTODY 20090400
AGENCY. IA0820100 BETTENDORF PD
CHARGE NO- 01 IA STATUTE IA3210r.2(A)
OPER VEH WH INT (OWI) / 18T OFFENSE
TRK#: 9A007X901
COURT DISPOSITION
AGENCY: IA082015J SCOTT CO DIST COURT
COUNT NO- 01 IA STATUTE: IA321J.2(A)
OPER VEH WH INT (OWI) / IST OPPENSE
COURT CASE ID: 07021 OWCX319739
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 9A007X901
SUBSTANCE ABUSE EVALUATION
SENTENCE DISP EFF DAT
SUSPENDED JAIL 118D 20090603
JAIL 12OD 20090603
FINE $1250
20090603
SUSPENDED FINE $625 20090603
PROBATION lY 20090603
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION 1r/
. 41 000
5MARTER I SIMPLER I CUSTOMER DRIVEN vvww,lowadot.gov
Inquiry Date:
4/28/2017
Customer #:
3854021
Name:
Mcfate, Daniel Ryan
Address: 108 PARKINGTON DR
City/State: MUSCATINE, IA 527615526
Mailing
108 PARKINGTON DR
Address:
NONE
Mailing
MUSCATINE, IA 527615526
Clty/State:
None
Date of Birth:
12/5/1977
Sex:
M
Convictions
Office of Driver Services
PO Box 92041 Des Moines, IA 50306-9204
Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837
w .lowadot.gov
Certified Abstract of Driving Record
DL/ID #: 838YY9925(IA)
Class: C
Audit #: 8773313
Issue Date: 01/16/2015
Expiration Date: 12/05/2020
Endorsements:
NONE
Restrictions:
NONE
Restriction
None
Supplement:
None
History Information
CDL Permit Class:
None
CDL Permit Issue
None
Date:
JUR
CDL Permit Expiration
None
Date:
!Operating While Intoxir_ated_
CDL Permit
None
Endorsements:
07/11/2013
CDL Permit
None
Restrictions:
IA
ID Status:
EXP
DL Status:
VAL
CDL Status:
None
CDL Permit Status:
ELG
CDL Cert Status:
None
CDL Med Status:
None
Zitation Date_
Conviction Date
ACD
Explanation
County
JUR
)4/08/2009
!06/03/2009
IA20
!Operating While Intoxir_ated_
Scott
IA
16/03/2013
07/11/2013
_ _
B64
'No Insurance Card
_ ,_ _
IA
10/25/2014
.12/08/2014
S92
_
!Speed
,M_uscatine
Polk _
IA
Operating While Intoxicated Test Refusal/Test Failure Violations
)ccurrence
ACD
Explanation
JUR
County
14/08/2009
A98
'OWI Test Failure
IIA
- -
Scott
Sanctions
type Effective End ACD Explanation _ occurrence JUR_ _ JUR
revoked 04/19/2009 10/15/2009 A98 'OWI Test Failure IA IA
Name: Mcfate, Daniel Ryan DL/ID: 838W9925
Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the
custodlan of the records held by the Office of Driver Services, that this Is a true and accurate copy of an official record currently in the custody of said office, and
that have been authorized by the Director of the Iowa Department of Transportation to so certify.
In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date:
pEHICtf 0 °u
D, 0. T.
4/28/2017
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'O "••••"5
hlh^ 8��
Office of Driver Services
Iowa Department of Transportation
Name: Mcfate, Daniel Ryan DL/ID: 838W9925